Author of

• 36336

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  P76 - Targeted Therapy - Clinically Focused - EGFR (ID 253)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Targeted Therapy - Clinically Focused
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 36441

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    P76.87 - Efficacy of Dacomitinib in EGFR TKI Refractory Metastatic Non-Small Cell Lung Cancer (EGFR Mutant) with Leptomeningeal Metastases (ID 3592)

    00:00 - 00:00  |  Presenting Author(s): Daniel Chan
    • Abstract
    • Slides

    Introduction
    

    Leptomeningeal disease in metastatic non-small cell lung cancer remains a challenging condition with guarded prognosis. Although several EGFR TKI (in particular osimertinib) have been reported to have good intra-cranial activity, however this has not been reported for dacomitinib as yet. Of note, brain metastases patients were excluded from the dacomitinib registration trial ARCHER 1050. This is in spite of the fact that pre-clinical data shows good levels of dacomitinib in the brain in mice-models.

    A pubmed search did not yield any case reports/ series on dacomitinib in leptomeningeal metastases in non-small cell lung cancer patients.

    The patient is a 73-year old lady with metastatic non-small cell lung cancer (adenocarcinoma) EGFR exon 21 L858R and EGFR exon 18 L718Q mutation who had failed prior Erlotinib, Afatinib, Osimertinib and Pemtrexed chemotherapy since her diagnosis in 2014.

    She developed status epilepticus due to progressive leptomeningeal metastases in March 2020 and was started on dacomitinib 15mg daily on an off-label basis. She had a clinical, CEA and MRI brain confirmed response. Two MRI brain scans done two months apart confirmed ongoing response.

    Methods
    

    This is a patient treated in a private medical oncology centre in Singapore by a medical oncologist.

    The patient and family agreed to off-label use of dacomitinib in leptomeningeal metastases as the patient otherwise was pre-morbidly well and ECOG Performance Status 1 and they were unwilling for the patient to undergo whole brain irradiation.

    Dacomitinib was started at 15mg daily with occasional doses at 30mg daily (limited by grade 3 diarrhea and rash).

    Regular clinical assessment, routine labs and CEA monitoring and MRI brain scan done after 2 and 4 months respectively of dacomitinib.

    Results
    

    

    MRI brain (Axial T1 + Gadolinium) - Left (baseline) Right (4 month mark)

    No further episodes of seizures were noted after commencing dacomitinib. Her dose of anti-epileptic also remained stable.

    CEA showed a decline from a peak of 17.4ug/L to a nadir of 9.3ug/L.

    MRI brain at 2 and 4 month mark showed improvement and stability of the leptomeningeal disease.

    The patient has been on dacomitinib for 5 months at this point in time (28 Aug 2020) and is continuing at 15mg/day

    Conclusion
    

    This is the world's first report on the intracranial activity of dacomitinib in leptomeningeal metastases.

    Larger scale studies in this group of patients of unmet need are warranted.

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